Thread by @DrSeunO

1/ Episode 3. #medicstoriesby@drseuno
Thanks to @BRANDENDOSERng for teaching me social media best practices.
Once again, this is a fictional, just trying to create awareness on #socioeconomic side of medicine.

2/ "good day everyone... How was your day after the revelations 2 days ago from the nurse" justice started.
"I hope you got a moment of respite as I didn't. The revelations caused me some deep thought. There are a lot of things, I couldn't just imagine"
#medicstoriesby@drseuno

3/ "Mrs Oluwakemi, how are the kids"
"they are good justice, my last born got admission to study medicine yesterday"
"makes me wonder, what kind of doctor he will be in the future." she said

4/ "talking about doctors, we didn't have enough time to take the doctor last time, he was on duty at the hospital, he is available to us today with ample amount of time" justice informed them

5/ "I'm going to abdicate the leadership of this panel to Prof. Doctor to doctor. It is your responsibility to find out the truth based on your knowledge, expertise and experience"

6/ "it will be a pleasure justice..."
"I hope you won't go easy on him, Mrs Oluwakemi enquired
"no má" Prof responded.

7/ Outside the hall, a young man seated. It felt like medical school all over again, waiting to be called for a viva but this time, his career could be on the line. How will he make this people understand, enlighten them.
"I'm no god" he said to himself

8/ "the panel is ready for you" he was jolted out of his soliloquy.
He stood up, followed the bailiff into the hall.
As he entered, he recognised a face. One of his professors in medical school was on the panel.
"it just had to be this man.. Haaa mo gbé"
#medicstoriesby@drseuno

9/ "sit down young man, we don't have all day" Prof started.
"my name is......."
"Professor Olubirin Adekunle, I know who you are" he completed prof sentence.
"you taught me community medicine in my school days"

10/ "good, let me introduce other members of this panel" Prof introduced everyone to him"
"for the record, we are not here to blame you or anyone, we just here for the truth and how we can prevent future occurrence"

11/ "if you will state your name for the record, then we will start off"
"my names are Michael Oluwafemi Agbaje, I'm a doctor, a Paediatric Resident, 12 years of clinical experience, 5 of which has been under Paediatric training"

12/ "the events of 10th March 2015, please" Mrs Oluwakemi said getting inpatient with all the pleasantries.

13/ "I was attending to a child, when I heard someone calling Dr, Dr, Dr, I turned around and saw a nurse run across with a child in her hands"
"Please tell me you were not the only one on duty, the nurse said, they were 3 nurses to 47 patients" justice said

14/ "I was the only resident on duty..........."
"Hell No" justice screamed slamming his hand on the table
"I had other junior colleagues, house officers and medical student working with me"
"that's relieving" justice sighed

15/ "I finished up on the child I was attending to and made my way to the nurse who was calling for attention"
"how long will you say it took you to get to the child, the mother claimed 7-8 mins, that you were sauntering your way down to them" Prof asked

16/ "No way it is 7-8 mins, I will say 2-3mins, and I was not sauntering, I was walking calmly. It is an emergency unit, I can't be running, creating panic in mothers whose emotion are already heightened, I can't run and collide with another person,

17/ I can't run and collide with someone holding a needle, and get a needle stick injury, running in an emergency unit borders on safety issues, it is inappropriate. I can't control how the mother perceive my actions" he said

18/ "please continue" Prof encouraged
"I got to the child, the nurse was just taking her vitals on him, she told me the O2 Sats is 83%, I asked her to titrate up to 98%.i examined the boy, he was very poorly, could hardly breath on his own. I listened to the chest"

19/ "I took some bloods and requested for... "
"let me stop you there. The mother said you took so much blood, would you say that could have contributed to the death of the child" Mrs Oluwakemi enquired

20/ Dr. Michael bursted into laughter... "he is a 7 years old boy that weighed 25kg. The minimum amount of blood flowing through his system is 1.75 Litres and the mother thinks taking blood samples of 20 millilitre is the cause of the death, you must see why I find that funny"

21/ "based on my suspicion, I asked for a Chest X-ray and decided antibiotics should be started with fluids. I won't see the child again till death"
"when my attention was called to his death, I ran there, and started CPR on him. In the process of doing that, the mother asked

22/ me to stop. I did as she requested, looked into her eyes and realised that she didn't understand what I was doing, so I continued again. We did all that for about 30mins before I proclaimed the child dead"

23/ "how would she have known what you were doing, when you never spoke to the parents, you ignored them totally. That is an attribute of a bad doctor. You are a very bad doctor" Mrs. Oluwakemi screamed

24/ "Mrs. Oluwakemi, I think we need to hold our emotions in check, we are all parents here. And am certain no one wants to lose a child. Doctor, how do you respond to the allegation that you didn't give a hoot about the child's parents" Prof asked

25/ "I'm sorry madam if you feel that way about me. The natural progression of consultation is History, examination, suspected diagnosis, investigation, confirmed diagnosis, treatment"
#medicstoriesby@drseuno

26/ "a patient in acute situation, you treat what can be treated without need for questions, this child had a Sats of 83%, God know how long that has been, if it continues further or goes lower, we might be looking at brain damage if he had survived"

27/ "so sue me for not following rules, I did what needed to be done. Not what the parent feels I should have done. More so, I asked my house officer to talk to the parents, which he did. If you look into the child case note, you will see her documentation"

28/ "let me get you right, a doctor actually spoke to the parent, the doctor wasn't just you. Why would the mother say no doctor spoke to her" Dr. Dalong said
"no, Dr. Dalong, she did not say no doctor spoke to her, she said this doctor ignored her and her husband" Mrs Oluwakemi

29/ "that is not surprising" Dr. Michael cut in
"junior doctors, medical student are hardly regarded in the frame of things. We see patient refusing to be clerked by medical student, some will say" má fi mí ṣé experiment"

30/ "whereas, that is where treatment starts from, more so being that they are in training, they will ask all questions possible. They also can paddle to the emotions of the relatives, but as usual we don't value basic, we want highfaluting, they want the conso"

31/ "so are you saying we should settle for less" justice asked
"No, I'm saying the government, especially tertiary hospital is nobody father's property. We had 47 patients on that day, only 15 of them fits the criteria for being in a tertiary centre"

32/ "the rest could be managed in a PHC or Private hospital, they are taken up space and human resources that is not enough for those who even require it. That's is part of the problem"

33/ "where are the PHC, reputable private hospitals(PH), some PH don't know what they are doing and then send patient to teaching hospital late in the night. Infact some just use patient to make money" Mrs Oluwakemi countered

34/ "all that you said are possibilities má, but it's also possible they have the wrong diagnosis or applying the wrong treatment, it is possible that they have treatment failure because the patient has already been self medicating"

35/ "that is why there is a need for a national treatment guideline, just like developed countries"

36/ "talking about problems, the nurse blames you for the death of the child, said the child required ICU monitoring, you mentioned it but didn't send the child to ICU, why is that?" Prof asked

37/ "I'm surprise the nurse will say that. I recognise how dangerous sepsis can be, I called the ICU and informed them that I want to send a patient to them for real time monitoring, however there was no bed space. The ICU was filled up. We have 8 ICU bed spaces"

38/ "that are meant for critical cases, especially patient whose heart and lungs can't perform their duty without assistance. Our ICU are been sold to the highest bidder"
"what do you mean by that?" justice asked leaning forward.

39/ "justice, what do you call it when an ICU bed is made available to someone because he jumped out of a moving car, no injures, no damage to Lungs/heart/brain. he claims to be ill, his colleague who happen to be a doctor said so.

40/ he is put in the ICU, using up space. What do you call that"
"so I did call ICU, I wanted the child in ICU. But ICU space was not available"

41/ "I have to ask this question as a mother concerned. Is there any chance that given the condition that child was brought in, he could have been saved" Mrs. Oluwakemi asked

42/ "Yes, even at the point where he appeared to be dead, he could still have been resuscitated. I mean, the nurse on duty has a PALS certificate, I have a PALS certificate... We both have the knowledge, but where is the equipment to work with"

43/ "we don't even have tools that can give us blood result in 3 to 5mins like our colleagues in the abroad, X-ray machines that gives result in 10mins tops, so I can't even make a ploy for crash trolley, infact that is too far. An AED will be nice"

44/ "what's an AED and what is the cost? " Mrs. Oluwakemi beckoned, she was scared of what she might hear
"AED stand for Automated Electrical Defibrillator, just at the point of death, there is a slight chance of resuscitation, an 8% chance of bringing the person back to life"

45/ "but 8% is a chance we have to take until there is no chance again"

46/ "to the cost, we will get a good one for 500k"
"wait, you are telling me that a tertiary hospital cannot afford a machine of 500k, my company paid tax to the tune of 3 million just last year." Mrs Oluwakemi said with anger in her voice.

47/ "that is what I'm indirectly saying má"
"look we know we can't save everyone, but we want to do our best, all of us health workers. We are in a game, a chess game. Our opponent is death, a master chess player and it hurt to start from the disadvantage position. It does hurt"

48/ "before you go Dr. Michael, what in your opinion are the major contribution to the child's death and how would you advise the citizens to approach their health" Aljiha asked.

49/ "in my opinion, the major factors will be the late presentation of the mother and the absence of equipment to work with. We have this knowledge, we know what to do, but we can't deliver. We just can't, at least not in the way Nigerians expect"

50/ "in our current situation, the best approach is preventive not therapeutic, don't even get the disease, and if you do, present early. Go to a hospital as quickly as possible. It's better to know its not a problem than to present late and create a mountain for us to climb"

51/ "thank you Dr. Michael, it has been a sad realisation of where we are and what we are healthwise. You may take your leave" justice said.
#medicstoriesby@drseuno

52/ "hmmm, ladies and gentlemen, I'm sad, really sad, very very sad" justice started
"when we set out for this task, I hoped it would be a quick one, it is turning out a sad one"
"we have heard from a mother who was self medicating, scared of going to a hospital"

53/ "scared of going to the hospital because of the outlook that the hospital present, a place of death"
"from nurse who demonstrated that they are persistently understaffed, poor team dynamics between healthcare workers"
#medicstoriesby@drseuno

54/ "now we have heard from the doctor, lack of equipments, time wasted on simple test, poor communication between patient and health worker and the most annoying, we are selling out, ICU given to the highest bidder... The poor is in trouble"

55/ "where do we go from here"
"we need to call it a day" I need to go home and sleep. It has been a sad day.
"when should we reconvene and who are we calling next... The minister of health or the hospital administrator?"

56/ "you want to call the minister" Aljiha asked with surprise.
"he asked us to get all the factor that may have contributed to the child death, it seems there are factors from his end. We won't have completed our job without calling him" justice responded

57/ "ok, I will say we speak to the hospital administrator first, then end it with the minister. We can then submit our findings and recommendations" Mrs. Oluwakemi said

58/ "that sound fine to me.. Let's reconvene on Friday. I have some court cases to attend to tomorrow. Have a good night and sleep well. I know I will definitely need that" justice concluded